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Doctors at the Ralph H. Johnson VA Medical Center in Charleston, S.C., and elsewhere throughout the Department of Veterans Affairs, are experimenting with potentially faster ways of providing relief to Veterans coping with posttraumatic stress disorder, or PTSD.

On the Edge

“PTSD is a condition that sometimes arises when a person is exposed to an extreme stress event, such as life threat, combat, or witnessing some sort of traumatic event,” explained Dr. Christopher Pelic, a psychiatrist with the Ralph H. Johnson VA Medical Center.

“Following exposure,” he continued, “you might have recurrent problems with nightmares, re-experiencing, feelings of being on edge, and avoidance of things that remind you of the events. These are commonplace. In some individuals, however, symptoms become so great that they can prevent you from performing your day-to-day activities. People avoid work, social settings, and life in general in order to withdraw to a perceived ‘safe zone.’”

Pelic said that to date, effective PTSD treatments include some medications, like Zoloft, and psychological interventions such as exposure-based treatments to diminish or even get rid of symptoms of PTSD. Remembering and imagining a traumatic event in detail repeatedly is a key component of exposure therapy.

“Exposure-based interventions have been very effective with about 65 percent of those treated,” Pelic said. “However, this means that 35 percent of behavior therapy patients are still experiencing significant symptoms.”

Treatments for PTSD work, yet VA is continually testing new approaches to treating PTSD that may produce better results, quicker.

“Combination Punch’ Could Mean Faster Relief

“Recently, we’ve been experimenting with several new technological and pharmacological advances, in combination with other therapies,” Pelic said. “We’re finding that this ‘combination approach’ may offer increased effectiveness over existing evidence-based treatments offered in isolation.”

One PTSD treatment being tested at VA is transcranial magnetic stimulation, or TMS. It is being combined with an existing therapy, prolonged exposure, in an attempt to enhance and accelerate treatment effects.

“We’re in the early stages of this type of therapy, but the results are encouraging. We've seen some of our patients experience a nice turnaround early on.”

— Dr. Ron Acierno, psychologist, Ralph H. Johnson VA Medical Center

Dr. Ron Acierno, a psychologist with the Ralph H. Johnson VA Medical Center, explained how it works: “The Veteran sits in a chair and thinks about the traumatic event they experienced while they were in the war zone. While that’s happening, magnetic pulses stimulate the part of the brain that allows you to feel in control of a situation. This is important, because one of the cardinal symptoms of PTSD is a sense of helplessness or lack of control over the event. Thus, when the patient is reminded of the event, these feelings of helplessness — this lack of control — returns.

“The theory,” he said, “is that combining stimulation of this brain center with exposure to the traumatic memory will allow patients to replace that sense of helplessness with a sense of perceived control over the disturbing memory.”

Acierno said TMS has already been used successfully in treating depression and now — when used in combination with prolonged exposure therapy — it appears to be generating positive results as a treatment for PTSD.

“Combining exposure therapy with TMS is a novel approach to treating PTSD,” he said. “We’re in the early stages of this type of therapy, but the results are encouraging. We've seen some of our patients experience a nice turnaround early on. We haven't had a large number of subjects, but we're seeing some good results.”

There’s No Place Like Home

Acierno noted that VA also offers Prolonged Exposure Therapy to Veterans in their homes through televideo technology.

“Specifically, VA researchers are assessing the safety implications and overall comparative effectiveness of conducting Prolonged Exposure Therapy over the computer or via iPads,” he said. “This saves travel time and increases session attendance. At VA we call this ‘meeting the Veterans where they’re at.’

“For example,” he continued, “they might have child care responsibilities, or they might spend a lot of time at work. Or they might live far away from a VA medical center. With an iPad or a home computer, or even a Smartphone, they’re connected to us, no matter where they are. They can still receive the same treatment.”

For more information on PTSD and available treatments, go to www.ptsd.va.gov.